(This article is being written in response to the Singapore Health Minister’s and the Catholic Church’s position on Legalised Euthanasia in Singapore. The original articles are reproduced below, after the author’s blog posting)
Last month, Mr Khaw Boon Wan asked: ‘Imagine that your TV is paid for by your Government or employer, as a gift.
‘Would you just settle for a 20-inch ordinary TV, or would you go for the top-end home cinema system, complete with karaoke and flat-screen LED monitor?’
But this is what is happening in health care, he said, adding that ‘gross abuses and over-consumption will have to be paid for, by all citizens, through higher taxes’.
If your child’s life depended on a medical drug to save him from death, would you go for a “20-inch ordinary” type of drug, or would you go all out to get him that “top-end home cinema system, complete with karaoke and flat-screen LED monitor” type of drug?
Mr Khaw is an engineer by training, and he is applying the economic principles of engineering to health-care. When you’re buying a TV, or buying a machine, you are balancing the economic value of your entertainment or machine productivity against the price you fork out. When the cost of repair exceeds the value it generates, you toss it out.
Health-care is totally different. How do you balance the value of a human life against a monetary price? When the state prevents people from getting more expensive healthcare by curbing subsidies, this is exactly what the state is doing. By legalising euthanasia, the state is sending out the message, ‘When the cost of repairing you exceeds the value you generate, you toss yourself out”
I am not a Catholic, and there are issues which I disagree with them, issues which I think they should practise but not impose on the larger public. But we should not be quick to dismiss or disagree with certain views just because they were first brought up by religious groups to which we do not belong.
In the issue of legalised euthanasia, we should really look at what the State is proposing. The State is trying to cut down on health and medical expenditure, by suggesting that “dying” should be one of the options to be considered. How far would the State subsidise your medical treatments before it deems that it is more cost effective for you to die than continue searching for a cure? This is a question we have to ask before agreeing to legalised euthanasia.
Let’s remember, there is a difference between euthanasia, the private individual’s decision, verus LEGALISED euthanasia, which we all must take a public stand on.
Legalised euthanasia is not just society’s collective position on euthanasia; it is also society’s collective position on healthcare. Should healthcare do everything to restore a person to health, or should healthcare do what is necessary to restore a person to health, for as long as it is economically viable? This is the crux of the issue, when the State begins to talk about the overwhelming cost of medical treatments, borne either by the state or the family. The next question, if you support legalized euthanasia, would of course be, how do you define the point where it is no longer economically viable for you to pursue healthcare?
Privately, many individuals and families already make this decision, when they decide whether or not to pursue medical treatment. That is an internal decision which is not feasible for the State to police or enforce, hence quite irrelevant to legislature. It is when the State agrees that economic viability should become a factor in public healthcare policy, that the issue of legalized euthanasia becomes very relevant. It affects how medical subsidies are given, it affects how the State pressures doctors to make recommendations to patients, it affects what kind of treatments the State chooses to make available to the masses.
I’m not sure if this is already happening anyway, at least not with critical end-of-life situations. However, with Cervical Cancer, we see that the State is already factoring in economic viability. It actively promotes regular Pap Smear screening for early detection of Cervical Cancer, which has a very good prognosis. But it does not promote, nor does it SUBSIDISE the cost of vaccines preventing cervical cancer, which currently costs SGD$700. To the state, when controlling the incidence and mortality of cervical cancer, spending $700 on each female is far less cost effective than spending much less on subsidized Pap Smears. However, to each individual female, the cost of getting cancer, and then doing something about it, is far most costly than getting a vaccine. But the average Singaporean female does not know about this and takes the government’s advice for everything.
Euthanasia is very different from the issue of abortion. I’m highly opposed to LEGALISED euthanasia (I’m not opposed to the individual making his or her own choice) , but I’m highly supportive of LEGALISED abortion.
Why the distinction?
If abortions were not legalized, what happens (and it happens in many countries without legalized abortions) is that females tend to go for backstreet jobs, where the mortality rate of abortions can go as high as 40%. Where abortions are legalized, as in Singapore, proper hospitals have reduced the mortality rate of abortions to below 2%.
Euthanasia is different. Whether it is legalized or not, people who really want to die will die, and the mortality rate of illegal euthanasia being 100% is not something we need to be indignant about, because that’s their goal! Where people have lost the capability to kill themselves, there is already the Advanced Medical Directive, which in its present state (the Health Minister wants it altered and expanded) enables people to prevent Assisted LIVING and not Assisted DYING – brain death is a mandatory criteria. With people who are not brain dead, but are physically unable to commit suicide, legalizing euthanasia might not help them, because this is a group of people most susceptible to abuse – physical, mental, emotional abuse. It is the State’s obligation to safeguard these people, and not put a price tag on their head to justify the abuse.
Nov 3, 2008
Euthanasia is immoral
Catholic Church condemns practice and urges doctors to reject it as it ‘violates medical ethics’.
By Lim Wei Chean
(http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_297852.html)
THE head of Singapore’s Catholic Church yesterday publicly condemned euthanasia, a topic that has grabbed headlines in recent weeks as the Government considers changes to the laws that govern dying.
Archbishop Nicholas Chia wrote a letter on mercy killings that was read out during Sunday services at the country’s 30-plus Catholic churches.
In it, he underlined the Church’s views on death, describing euthanasia as ‘immoral’ and also calling on doctors to reject the practice.
‘One cannot choose death and ask to be killed. When they do this, they are not only committing the crime of suicide, but also compounding it by making another person a partner in a crime,’ he wrote.
Health Minister Khaw Boon Wan discussed the issue of euthanasia last month after it was raised in the press.
The Government has not proposed legalising the practice, but has broached the idea of making changes to the Advance Medical Directive, or living will. The document instructs doctors not to artificially prolong the life of a terminally-ill patient with machines. The changes would make it easier for Singaporeans to turn down that care.
Opponents say that is one step on the slippery slope to euthanasia, which the Catholic Church has long considered taboo alongside other controversial practices like abortion.
Archbishop Chia condemned mercy killings in his letter, which was read out All Souls’ Day, the annual day of remembering the dead.
‘One must not yield to another’s person’s request for euthanasia. To yield to such a request is false compassion,’ he wrote to Singapore’s 320,000-strong Catholic population.
‘To have true compassion for the person is to understand (they are) actually feeling lost, confused, hopeless and alienated. Mercy entails supporting such person through care and friendship.’
The archbishop also called on doctors to reject mercy-killings, saying they were a violation of medical ethics. ‘No health-care professionals must even contemplate the option of administering euthanasia,’ he wrote.
The Head of the Catholic Medical Guild, a group of religious medical professionals, said she wholeheartedly agrees with the archbishop.
‘Taking one’s life or assisting another person to take his life is immoral,’ said Dr Sally Ho.
Most times, people do not want to die, she said. Instead, they want to end the pain they are feeling, so ensuring patients receive proper palliative care is crucial.
The Catholic Church in its fortnightly newsletter had an article on euthanasia written by one of its priests. In the Catholic News, the priest said it is important to offer palliative care.
The Methodist and the Anglican churches, as well as the National Council of Churches, could not be reached for comment yesterday.
While several countries make it relatively easy for the terminally-ill to decline treatment, few have actually taken the step of allowing doctors to end the lives of patients. Only the Netherlands and the state of Oregon in the United States allow the controversial practice.
Archbishop Chia told The Straits Times in an interview yesterday: ‘This is a matter of life and death. It is not up to you or me to decide.’
Oct 18, 2008
Yes or no to euthanasia?
Health Minister raises ethical end-of-life issues Singapore will have to confront
By Salma Khalik, Health Correspondent
(http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_291904.html)
FOR the second time this week, the Health Minister has surfaced euthanasia as an ethical dilemma that Singapore would have to confront.
‘Do we allow euthanasia or assisted dying?’ asked Mr Khaw Boon Wan when he spoke on challenges in the health-care sector last night to an audience of engineers.
As he did on Wednesday, he noted that the Chinese daily Lianhe Zaobao has published several letters from readers on ‘this complicated but pertinent issue’.
One man, he said yesterday, even photocopied a page of letters for him, asking that he legislate euthanasia – a message the man conveyed in red ink.
End-of-life issues are expected to be on his ministry’s agenda next year, but it appears that he wants more debate on other ethical dilemmas that ageing and developed countries are grappling with.
He referred to the recent debate on organ trading, a divisive issue sparked by the recent nabbing of a case here.
It is expected to be raised again when the planned changes to the Human Organ Transplant Act to increase the supply of cadaveric kidneys come up for debate soon.
Yesterday, he threw up another example yesterday: ‘Should we allow surrogate pregnancy?’
India has legalised this but critics say the poor are being exploited by the rich who can afford to ‘rent a womb’, he noted. Others, however, see it as a normal commercial transaction benefiting both parties.
Besides confronting ethical issues, another challenge is deciding how much to spend on health care, given a rapidly ageing population, rising expectations and escalating costs.
The current health-care model is ‘inadequate’ for future needs.
So long as someone else pays – be it the Government, employer or insurer – demand for medical treatments will be high, including some that are unnecessary.
He asked: ‘Imagine that your TV is paid for by your Government or employer, as a gift.
‘Would you just settle for a 20-inch ordinary TV, or would you go for the top-end home cinema system, complete with karaoke and flat-screen LED monitor?’
But this is what is happening in health care, he said, adding that ‘gross abuses and over-consumption will have to be paid for, by all citizens, through higher taxes’.
This is further fuelled by unrealistic expectations. He said: ‘In times of grief, family members often do not accept the limits of medical science. Many seem to forget that we are all mortals.’
Whatever the solution, some basic principles should be maintained, such as focusing on prevention rather than cure, said Mr Khaw at the the Institution of Engineers’ annual dinner and dance.
Himself an engineer by training, he said: ‘As engineers, we know the preventive strategy instinctively.’
They know, for example, that servicing a car regularly is cheaper than sending it to a workshop for repairs. But he added: ‘The average car owner looks after his car better than his own body.’
Another principle: Making health care more like other sectors, with competition leading to greater choices, higher standards and cheaper services.
Like other industries, innovative business models should be encouraged.
‘Hence, my preference for diversity in health-care providers, the more the better.’ They will give patients more choice, and create space for mavericks and innovators.
‘Not all innovations will succeed, but if there is no opportunity to even experiment, we will be stuck with the status quo,’ he added.
salma@sph.com.sg
Against State LEGALISED Euthanasia (as opposed to Euthanasia)
(This article is being written in response to the Singapore Health Minister’s and the Catholic Church’s position on Legalised Euthanasia in Singapore. The original articles are reproduced below, after the author’s blog posting)
Last month, Mr Khaw Boon Wan asked: ‘Imagine that your TV is paid for by your Government or employer, as a gift.
‘Would you just settle for a 20-inch ordinary TV, or would you go for the top-end home cinema system, complete with karaoke and flat-screen LED monitor?’
But this is what is happening in health care, he said, adding that ‘gross abuses and over-consumption will have to be paid for, by all citizens, through higher taxes’.
If your child’s life depended on a medical drug to save him from death, would you go for a “20-inch ordinary” type of drug, or would you go all out to get him that “top-end home cinema system, complete with karaoke and flat-screen LED monitor” type of drug?
Mr Khaw is an engineer by training, and he is applying the economic principles of engineering to health-care. When you’re buying a TV, or buying a machine, you are balancing the economic value of your entertainment or machine productivity against the price you fork out. When the cost of repair exceeds the value it generates, you toss it out.
Health-care is totally different. How do you balance the value of a human life against a monetary price? When the state prevents people from getting more expensive healthcare by curbing subsidies, this is exactly what the state is doing. By legalising euthanasia, the state is sending out the message, ‘When the cost of repairing you exceeds the value you generate, you toss yourself out”
I am not a Catholic, and there are issues which I disagree with them, issues which I think they should practise but not impose on the larger public. But we should not be quick to dismiss or disagree with certain views just because they were first brought up by religious groups to which we do not belong.
In the issue of legalised euthanasia, we should really look at what the State is proposing. The State is trying to cut down on health and medical expenditure, by suggesting that “dying” should be one of the options to be considered. How far would the State subsidise your medical treatments before it deems that it is more cost effective for you to die than continue searching for a cure? This is a question we have to ask before agreeing to legalised euthanasia.
Let’s remember, there is a difference between euthanasia, the private individual’s decision, verus LEGALISED euthanasia, which we all must take a public stand on.
Legalised euthanasia is not just society’s collective position on euthanasia; it is also society’s collective position on healthcare. Should healthcare do everything to restore a person to health, or should healthcare do what is necessary to restore a person to health, for as long as it is economically viable? This is the crux of the issue, when the State begins to talk about the overwhelming cost of medical treatments, borne either by the state or the family. The next question, if you support legalized euthanasia, would of course be, how do you define the point where it is no longer economically viable for you to pursue healthcare?
Privately, many individuals and families already make this decision, when they decide whether or not to pursue medical treatment. That is an internal decision which is not feasible for the State to police or enforce, hence quite irrelevant to legislature. It is when the State agrees that economic viability should become a factor in public healthcare policy, that the issue of legalized euthanasia becomes very relevant. It affects how medical subsidies are given, it affects how the State pressures doctors to make recommendations to patients, it affects what kind of treatments the State chooses to make available to the masses.
I’m not sure if this is already happening anyway, at least not with critical end-of-life situations. However, with Cervical Cancer, we see that the State is already factoring in economic viability. It actively promotes regular Pap Smear screening for early detection of Cervical Cancer, which has a very good prognosis. But it does not promote, nor does it SUBSIDISE the cost of vaccines preventing cervical cancer, which currently costs SGD$700. To the state, when controlling the incidence and mortality of cervical cancer, spending $700 on each female is far less cost effective than spending much less on subsidized Pap Smears. However, to each individual female, the cost of getting cancer, and then doing something about it, is far most costly than getting a vaccine. But the average Singaporean female does not know about this and takes the government’s advice for everything.
Euthanasia is very different from the issue of abortion. I’m highly opposed to LEGALISED euthanasia (I’m not opposed to the individual making his or her own choice) , but I’m highly supportive of LEGALISED abortion.
Why the distinction?
If abortions were not legalized, what happens (and it happens in many countries without legalized abortions) is that females tend to go for backstreet jobs, where the mortality rate of abortions can go as high as 40%. Where abortions are legalized, as in Singapore, proper hospitals have reduced the mortality rate of abortions to below 2%.
Euthanasia is different. Whether it is legalized or not, people who really want to die will die, and the mortality rate of illegal euthanasia being 100% is not something we need to be indignant about, because that’s their goal! Where people have lost the capability to kill themselves, there is already the Advanced Medical Directive, which in its present state (the Health Minister wants it altered and expanded) enables people to prevent Assisted LIVING and not Assisted DYING – brain death is a mandatory criteria. With people who are not brain dead, but are physically unable to commit suicide, legalizing euthanasia might not help them, because this is a group of people most susceptible to abuse – physical, mental, emotional abuse. It is the State’s obligation to safeguard these people, and not put a price tag on their head to justify the abuse.
Nov 3, 2008
Euthanasia is immoral
Catholic Church condemns practice and urges doctors to reject it as it ‘violates medical ethics’.
By Lim Wei Chean
(http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_297852.html)
THE head of Singapore’s Catholic Church yesterday publicly condemned euthanasia, a topic that has grabbed headlines in recent weeks as the Government considers changes to the laws that govern dying.
Archbishop Nicholas Chia wrote a letter on mercy killings that was read out during Sunday services at the country’s 30-plus Catholic churches.
In it, he underlined the Church’s views on death, describing euthanasia as ‘immoral’ and also calling on doctors to reject the practice.
‘One cannot choose death and ask to be killed. When they do this, they are not only committing the crime of suicide, but also compounding it by making another person a partner in a crime,’ he wrote.
Health Minister Khaw Boon Wan discussed the issue of euthanasia last month after it was raised in the press.
The Government has not proposed legalising the practice, but has broached the idea of making changes to the Advance Medical Directive, or living will. The document instructs doctors not to artificially prolong the life of a terminally-ill patient with machines. The changes would make it easier for Singaporeans to turn down that care.
Opponents say that is one step on the slippery slope to euthanasia, which the Catholic Church has long considered taboo alongside other controversial practices like abortion.
Archbishop Chia condemned mercy killings in his letter, which was read out All Souls’ Day, the annual day of remembering the dead.
‘One must not yield to another’s person’s request for euthanasia. To yield to such a request is false compassion,’ he wrote to Singapore’s 320,000-strong Catholic population.
‘To have true compassion for the person is to understand (they are) actually feeling lost, confused, hopeless and alienated. Mercy entails supporting such person through care and friendship.’
The archbishop also called on doctors to reject mercy-killings, saying they were a violation of medical ethics. ‘No health-care professionals must even contemplate the option of administering euthanasia,’ he wrote.
The Head of the Catholic Medical Guild, a group of religious medical professionals, said she wholeheartedly agrees with the archbishop.
‘Taking one’s life or assisting another person to take his life is immoral,’ said Dr Sally Ho.
Most times, people do not want to die, she said. Instead, they want to end the pain they are feeling, so ensuring patients receive proper palliative care is crucial.
The Catholic Church in its fortnightly newsletter had an article on euthanasia written by one of its priests. In the Catholic News, the priest said it is important to offer palliative care.
The Methodist and the Anglican churches, as well as the National Council of Churches, could not be reached for comment yesterday.
While several countries make it relatively easy for the terminally-ill to decline treatment, few have actually taken the step of allowing doctors to end the lives of patients. Only the Netherlands and the state of Oregon in the United States allow the controversial practice.
Archbishop Chia told The Straits Times in an interview yesterday: ‘This is a matter of life and death. It is not up to you or me to decide.’
Oct 18, 2008
Yes or no to euthanasia?
Health Minister raises ethical end-of-life issues Singapore will have to confront
By Salma Khalik, Health Correspondent
(http://www.straitstimes.com/Breaking%2BNews/Singapore/Story/STIStory_291904.html)
FOR the second time this week, the Health Minister has surfaced euthanasia as an ethical dilemma that Singapore would have to confront.
‘Do we allow euthanasia or assisted dying?’ asked Mr Khaw Boon Wan when he spoke on challenges in the health-care sector last night to an audience of engineers.
As he did on Wednesday, he noted that the Chinese daily Lianhe Zaobao has published several letters from readers on ‘this complicated but pertinent issue’.
One man, he said yesterday, even photocopied a page of letters for him, asking that he legislate euthanasia – a message the man conveyed in red ink.
End-of-life issues are expected to be on his ministry’s agenda next year, but it appears that he wants more debate on other ethical dilemmas that ageing and developed countries are grappling with.
He referred to the recent debate on organ trading, a divisive issue sparked by the recent nabbing of a case here.
It is expected to be raised again when the planned changes to the Human Organ Transplant Act to increase the supply of cadaveric kidneys come up for debate soon.
Yesterday, he threw up another example yesterday: ‘Should we allow surrogate pregnancy?’
India has legalised this but critics say the poor are being exploited by the rich who can afford to ‘rent a womb’, he noted. Others, however, see it as a normal commercial transaction benefiting both parties.
Besides confronting ethical issues, another challenge is deciding how much to spend on health care, given a rapidly ageing population, rising expectations and escalating costs.
The current health-care model is ‘inadequate’ for future needs.
So long as someone else pays – be it the Government, employer or insurer – demand for medical treatments will be high, including some that are unnecessary.
He asked: ‘Imagine that your TV is paid for by your Government or employer, as a gift.
‘Would you just settle for a 20-inch ordinary TV, or would you go for the top-end home cinema system, complete with karaoke and flat-screen LED monitor?’
But this is what is happening in health care, he said, adding that ‘gross abuses and over-consumption will have to be paid for, by all citizens, through higher taxes’.
This is further fuelled by unrealistic expectations. He said: ‘In times of grief, family members often do not accept the limits of medical science. Many seem to forget that we are all mortals.’
Whatever the solution, some basic principles should be maintained, such as focusing on prevention rather than cure, said Mr Khaw at the the Institution of Engineers’ annual dinner and dance.
Himself an engineer by training, he said: ‘As engineers, we know the preventive strategy instinctively.’
They know, for example, that servicing a car regularly is cheaper than sending it to a workshop for repairs. But he added: ‘The average car owner looks after his car better than his own body.’
Another principle: Making health care more like other sectors, with competition leading to greater choices, higher standards and cheaper services.
Like other industries, innovative business models should be encouraged.
‘Hence, my preference for diversity in health-care providers, the more the better.’ They will give patients more choice, and create space for mavericks and innovators.
‘Not all innovations will succeed, but if there is no opportunity to even experiment, we will be stuck with the status quo,’ he added.
salma@sph.com.sg